SENATE AMENDMENT
    Bill No. HB 1843, 1st Eng.
    Amendment No. ___   Barcode 822742
                            CHAMBER ACTION
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11  Senator Peaden moved the following amendment:
12  
13         Senate Amendment (with title amendment) 
14         Delete everything after the enacting clause
15  
16  and insert:  
17         Section 1.  Section 216.341, Florida Statutes, is
18  amended to read:
19         216.341  Disbursement of Department of Health county
20  health department trust funds; appropriation of authorized
21  positions.--
22         (1)  County health department trust funds may be
23  expended by the Department of Health for the respective county
24  health departments in accordance with budgets and plans agreed
25  upon by the county authorities of each county and the
26  Department of Health.
27         (2)  The requirement limitations on appropriations
28  provided in s. 216.262(1) shall not apply to Department of
29  Health positions funded by:
30         (a)  County health department trust funds; or.
31         (b)  The United States Trust Fund.
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SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 Section 2. Effective May 1, 2004, paragraph (a) of 2 subsection (3) of section 400.23, Florida Statutes, is amended 3 to read: 4 400.23 Rules; evaluation and deficiencies; licensure 5 status.-- 6 (3)(a) The agency shall adopt rules providing for the 7 minimum staffing standards requirements for nursing homes. 8 These standards requirements shall require include, in for 9 each nursing home facility, a minimum certified nursing 10 assistant staffing of 2.3 hours of direct care per resident 11 per day beginning January 1, 2002, and increasing to 2.6 hours 12 of direct care per resident per day beginning January 1, 2003, 13 and increasing to 2.9 hours of direct care per resident per 14 day beginning May 1, 2004. Beginning January 1, 2002, no 15 facility shall staff below one certified nursing assistant per 16 20 residents, and a minimum licensed nursing staffing of 1.0 17 hour of direct resident care per resident per day but never 18 below one licensed nurse per 40 residents. Nursing assistants 19 employed never below one licensed nurse per 40 residents. 20 Nursing assistants employed under s. 400.211(2) may be 21 included in computing the staffing ratio for certified nursing 22 assistants only if they provide nursing assistance services to 23 residents on a full-time basis. Each nursing home must 24 document compliance with staffing standards as required under 25 this paragraph and post daily the names of staff on duty for 26 the benefit of facility residents and the public. The agency 27 shall recognize the use of licensed nurses for compliance with 28 minimum staffing requirements for certified nursing 29 assistants, provided that the facility otherwise meets the 30 minimum staffing requirements for licensed nurses and that the 31 licensed nurses so recognized are performing the duties of a 2 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 certified nursing assistant. Unless otherwise approved by the 2 agency, licensed nurses counted towards the minimum staffing 3 requirements for certified nursing assistants must exclusively 4 perform the duties of a certified nursing assistant for the 5 entire shift and shall not also be counted towards the minimum 6 staffing requirements for licensed nurses. If the agency 7 approved a facility's request to use a licensed nurse to 8 perform both licensed nursing and certified nursing assistant 9 duties, the facility must allocate the amount of staff time 10 specifically spent on each set of certified nursing assistant 11 duties for the purpose of documenting compliance with minimum 12 staffing requirements for certified and licensed nursing 13 staff. In no event may the hours of a licensed nurse with dual 14 job responsibilities be counted twice. 15 Section 3. Section 409.814, Florida Statutes, as 16 amended by CS for SB 2000, 1st engrossed, is amended to read: 17 409.814 Eligibility.--A child who has not reached 19 18 years of age whose family income is equal to or below 200 19 percent of the federal poverty level is eligible for the 20 Florida KidCare program as provided in this section. A child 21 who is otherwise eligible for KidCare and who has a 22 preexisting condition that prevents coverage under another 23 insurance plan as described in subsection (4) which would have 24 disqualified the child for KidCare if the child were able to 25 enroll in the plan shall be eligible for KidCare coverage when 26 enrollment is possible. For enrollment in the Children's 27 Medical Services network, a complete application includes the 28 medical or behavioral health screening. If, subsequently, an 29 individual is determined to be ineligible for coverage, he or 30 she must immediately be disenrolled from the respective 31 Florida KidCare program component. 3 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 (1) A child who is eligible for Medicaid coverage 2 under s. 409.903 or s. 409.904 must be enrolled in Medicaid 3 and is not eligible to receive health benefits under any other 4 health benefits coverage authorized under the Florida KidCare 5 program. 6 (2) A child who is not eligible for Medicaid, but who 7 is eligible for the Florida KidCare program, may obtain health 8 benefits coverage under any of the other components listed in 9 s. 409.813 if such coverage is approved and available in the 10 county in which the child resides. However, a child who is 11 eligible for Medikids may participate in the Florida Healthy 12 Kids program only if the child has a sibling participating in 13 the Florida Healthy Kids program and the child's county of 14 residence permits such enrollment. 15 (3) A child who is eligible for the Florida KidCare 16 program who is a child with special health care needs, as 17 determined through a medical or behavioral screening 18 instrument, is eligible for health benefits coverage from and 19 shall be referred to the Children's Medical Services network. 20 (4) The following children are not eligible to receive 21 premium assistance for health benefits coverage under the 22 Florida KidCare program, except under Medicaid if the child 23 would have been eligible for Medicaid under s. 409.903 or s. 24 409.904 as of June 1, 1997: 25 (a) A child who is eligible for coverage under a state 26 health benefit plan on the basis of a family member's 27 employment with a public agency in the state. 28 (b) A child who is currently eligible for or covered 29 under a family member's group health benefit plan or under 30 other employer health insurance coverage, excluding coverage 31 provided under the Florida Healthy Kids Corporation as 4 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 established under s. 624.91, provided that the cost of the 2 child's participation is not greater than 5 percent of the 3 family's income. This provision shall be applied during 4 redetermination for children who were enrolled prior to July 5 1, 2004. These enrollees shall have 6 months of eligibility 6 following redetermination to allow for a transition to the 7 other health benefit plan. 8 (c) A child who is seeking premium assistance for the 9 Florida KidCare program through employer-sponsored group 10 coverage, if the child has been covered by the same employer's 11 group coverage during the 6 months prior to the family's 12 submitting an application for determination of eligibility 13 under the program. 14 (d) A child who is an alien, but who does not meet the 15 definition of qualified alien, in the United States. 16 (e) A child who is an inmate of a public institution 17 or a patient in an institution for mental diseases. 18 (f) A child who has had his or her coverage in an 19 employer-sponsored health benefit plan voluntarily canceled in 20 the last 6 months, except those children who were on the 21 waiting list prior to January 31, 2004. 22 (5) A child whose family income is above 200 percent 23 of the federal poverty level or a child who is excluded under 24 the provisions of subsection (4) may participate in the 25 Florida KidCare program, excluding the Medicaid program, but 26 is subject to the following provisions: 27 (a) The family is not eligible for premium assistance 28 payments and must pay the full cost of the premium, including 29 any administrative costs. 30 (b) The agency is authorized to place limits on 31 enrollment in Medikids by these children in order to avoid 5 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 adverse selection. The number of children participating in 2 Medikids whose family income exceeds 200 percent of the 3 federal poverty level must not exceed 10 percent of total 4 enrollees in the Medikids program. 5 (c) The board of directors of the Florida Healthy Kids 6 Corporation is authorized to place limits on enrollment of 7 these children in order to avoid adverse selection. In 8 addition, the board is authorized to offer a reduced benefit 9 package to these children in order to limit program costs for 10 such families. The number of children participating in the 11 Florida Healthy Kids program whose family income exceeds 200 12 percent of the federal poverty level must not exceed 10 13 percent of total enrollees in the Florida Healthy Kids 14 program. 15 (d) Children described in this subsection are not 16 counted in the annual enrollment ceiling for the Florida 17 KidCare program. 18 (6) Once a child is enrolled in the Florida KidCare 19 program, the child is eligible for coverage under the program 20 for 6 months without a redetermination or reverification of 21 eligibility, if the family continues to pay the applicable 22 premium. Eligibility for program components funded through 23 Title XXI of the Social Security Act shall terminate when a 24 child attains the age of 19. Effective January 1, 1999, a 25 child who has not attained the age of 5 and who has been 26 determined eligible for the Medicaid program is eligible for 27 coverage for 12 months without a redetermination or 28 reverification of eligibility. 29 (7) When determining or reviewing a child's 30 eligibility under the Florida KidCare program, the applicant 31 shall be provided with reasonable notice of changes in 6 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 eligibility which may affect enrollment in one or more of the 2 program components. When a transition from one program 3 component to another is authorized, there shall be cooperation 4 between the program components and the affected family which 5 promotes continuity of health care coverage. Any authorized 6 transfers must be managed within the program's overall 7 appropriated or authorized levels of funding. Each component 8 of the program shall establish a reserve to ensure that 9 transfers between components will be accomplished within 10 current year appropriations. These reserves shall be reviewed 11 by each convening of the Social Services Estimating Conference 12 to determine the adequacy of such reserves to meet actual 13 experience. 14 (8) In determining the eligibility of a child, an 15 assets test is not required. Each applicant shall provide 16 written documentation during the application process and the 17 redetermination process, including, but not limited to, the 18 following: 19 (a) Proof of family income supported by copies of any 20 federal income tax return for the prior year, any wages and 21 earnings statements (W-2 forms), and any other appropriate 22 document. 23 (b) A statement from all family members that: 24 1. Their employer does not sponsor a health benefit 25 plan for employees; or 26 2. The potential enrollee is not covered by the 27 employer-sponsored health benefit plan because the potential 28 enrollee is not eligible for coverage, or, if the potential 29 enrollee is eligible but not covered, a statement of the cost 30 to enroll the potential enrollee in the employer-sponsored 31 health benefit plan. 7 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 (9) Subject to paragraph (4)(b) and s. 624.91(3), the 2 Florida KidCare program shall withhold benefits from an 3 enrollee if the program obtains evidence that the enrollee is 4 no longer eligible, submitted incorrect or fraudulent 5 information in order to establish eligibility, or failed to 6 provide verification of eligibility. The applicant or enrollee 7 shall be notified that because of such evidence program 8 benefits will be withheld unless the applicant or enrollee 9 contacts a designated representative of the program by a 10 specified date, which must be within 10 days after the date of 11 notice, to discuss and resolve the matter. The program shall 12 make every effort to resolve the matter within a timeframe 13 that will not cause benefits to be withheld from an eligible 14 enrollee. 15 (10) The following individuals may be subject to 16 prosecution in accordance with s. 414.39: 17 (a) An applicant obtaining or attempting to obtain 18 benefits for a potential enrollee under the Florida KidCare 19 program when the applicant knows or should have known the 20 potential enrollee does not qualify for the Florida KidCare 21 program. 22 (b) An individual who assists an applicant in 23 obtaining or attempting to obtain benefits for a potential 24 enrollee under the Florida KidCare program when the individual 25 knows or should have known the potential enrollee does not 26 qualify for the Florida KidCare program. 27 Section 4. Subsection (5) of section 409.903, Florida 28 Statutes, is amended to read: 29 409.903 Mandatory payments for eligible persons.--The 30 agency shall make payments for medical assistance and related 31 services on behalf of the following persons who the 8 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 department, or the Social Security Administration by contract 2 with the Department of Children and Family Services, 3 determines to be eligible, subject to the income, assets, and 4 categorical eligibility tests set forth in federal and state 5 law. Payment on behalf of these Medicaid eligible persons is 6 subject to the availability of moneys and any limitations 7 established by the General Appropriations Act or chapter 216. 8 (5) Effective October 1, 2004, a pregnant woman for 9 the duration of her pregnancy and for the postpartum period as 10 defined in federal law and rule, or a child under age 1, if 11 either is living in a family that has an income which is at or 12 below 150 percent of the most current federal poverty level, 13 or, effective January 1, 1992, that has an income which is at 14 or below 185 percent of the most current federal poverty 15 level. Such a person is not subject to an assets test. 16 Further, a pregnant woman who applies for eligibility for the 17 Medicaid program through a qualified Medicaid provider must be 18 offered the opportunity, subject to federal rules, to be made 19 presumptively eligible for the Medicaid program. 20 Section 5. Subsections (2), (3), and (8) of section 21 409.904, Florida Statutes, are amended to read: 22 409.904 Optional payments for eligible persons.--The 23 agency may make payments for medical assistance and related 24 services on behalf of the following persons who are determined 25 to be eligible subject to the income, assets, and categorical 26 eligibility tests set forth in federal and state law. Payment 27 on behalf of these Medicaid eligible persons is subject to the 28 availability of moneys and any limitations established by the 29 General Appropriations Act or chapter 216. 30 (2) A family, a pregnant woman, a child under age 21, 31 a person age 65 or over, or a blind or disabled person, who 9 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 would be eligible under any group listed in s. 409.903(1), 2 (2), or (3), except that the income or assets of such family 3 or person exceed established limitations. For a family or 4 person in one of these coverage groups, medical expenses are 5 deductible from income in accordance with federal requirements 6 in order to make a determination of eligibility. Children and 7 pregnant women A family or person eligible under the coverage 8 known as the "medically needy," are is eligible to receive the 9 same services as other Medicaid recipients, with the exception 10 of services in skilled nursing facilities and intermediate 11 care facilities for the developmentally disabled. Effective 12 January 1, 2005, parents or caretaker relatives of children 13 eligible under the coverage known as "medically needy" and 14 aged, blind, or disabled persons eligible under such coverage 15 are limited to pharmacy services only. 16 (3) A person who is in need of the services of a 17 licensed nursing facility, a licensed intermediate care 18 facility for the developmentally disabled, or a state mental 19 hospital, whose income does not exceed 300 percent of the SSI 20 income standard, and who meets the assets standards 21 established under federal and state law. In determining the 22 person's responsibility for the cost of care, the following 23 amounts must be deducted from the person's income: 24 (a) The monthly personal allowance for residents as 25 set based on appropriations. 26 (b) The reasonable costs of medically necessary 27 services and supplies that are not reimbursable by the 28 Medicaid program. 29 (c) The cost of premiums, copayments, coinsurance, and 30 deductibles for supplemental health insurance. 31 (8) Effective October 1, 2004, a child under 1 year of 10 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 age who lives in a family that has an income above 150 185 2 percent of the most recently published federal poverty level, 3 but which is at or below 200 percent of such poverty level. In 4 determining the eligibility of such child, an assets test is 5 not required. A child who is eligible for Medicaid under this 6 subsection must be offered the opportunity, subject to federal 7 rules, to be made presumptively eligible. 8 Section 6. Section 409.905, Florida Statutes, is 9 amended to read: 10 409.905 Mandatory Medicaid services.--The agency may 11 make payments for the following services, which are required 12 of the state by Title XIX of the Social Security Act, 13 furnished by Medicaid providers to recipients who are 14 determined to be eligible on the dates on which the services 15 were provided. Any service under this section shall be 16 provided only when medically necessary and in accordance with 17 state and federal law. Mandatory services rendered by 18 providers in mobile units to Medicaid recipients may be 19 restricted by the agency. Nothing in this section shall be 20 construed to prevent or limit the agency from adjusting fees, 21 reimbursement rates, lengths of stay, number of visits, number 22 of services, or any other adjustments necessary to comply with 23 the availability of moneys and any limitations or directions 24 provided for in the General Appropriations Act or chapter 216. 25 (1) ADVANCED REGISTERED NURSE PRACTITIONER 26 SERVICES.--The agency shall pay for services provided to a 27 recipient by a licensed advanced registered nurse practitioner 28 who has a valid collaboration agreement with a licensed 29 physician on file with the Department of Health or who 30 provides anesthesia services in accordance with established 31 protocol required by state law and approved by the medical 11 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 staff of the facility in which the anesthetic service is 2 performed. Reimbursement for such services must be provided in 3 an amount that equals not less than 80 percent of the 4 reimbursement to a physician who provides the same services, 5 unless otherwise provided for in the General Appropriations 6 Act. 7 (2) EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND 8 TREATMENT SERVICES.--The agency shall pay for early and 9 periodic screening and diagnosis of a recipient under age 21 10 to ascertain physical and mental problems and conditions and 11 provide treatment to correct or ameliorate these problems and 12 conditions. These services include all services determined by 13 the agency to be medically necessary for the treatment, 14 correction, or amelioration of these problems, including 15 personal care, private duty nursing, durable medical 16 equipment, physical therapy, occupational therapy, speech 17 therapy, respiratory therapy, and immunizations. 18 (3) FAMILY PLANNING SERVICES.--The agency shall pay 19 for services necessary to enable a recipient voluntarily to 20 plan family size or to space children. These services include 21 information; education; counseling regarding the availability, 22 benefits, and risks of each method of pregnancy prevention; 23 drugs and supplies; and necessary medical care and followup. 24 Each recipient participating in the family planning portion of 25 the Medicaid program must be provided freedom to choose any 26 alternative method of family planning, as required by federal 27 law. 28 (4) HOME HEALTH CARE SERVICES.--The agency shall pay 29 for nursing and home health aide services, supplies, 30 appliances, and durable medical equipment, necessary to assist 31 a recipient living at home. An entity that provides services 12 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 pursuant to this subsection shall be licensed under part IV of 2 chapter 400 or part II of chapter 499, if appropriate. These 3 services, equipment, and supplies, or reimbursement therefor, 4 may be limited as provided in the General Appropriations Act 5 and do not include services, equipment, or supplies provided 6 to a person residing in a hospital or nursing facility. 7 (a) In providing home health care services, the agency 8 may require prior authorization of care based on diagnosis. 9 (b) Effective November 1, 2004, the agency shall 10 implement a comprehensive utilization program that requires 11 prior authorization of all private duty nursing services for 12 children, including children served by the Department of 13 Health's Children's Medical Services program. The agency may 14 competitively bid a contract to select a qualified 15 organization to provide such services. The agency may seek 16 federal waiver approval as necessary to implement this policy. 17 (5) HOSPITAL INPATIENT SERVICES.--The agency shall pay 18 for all covered services provided for the medical care and 19 treatment of a recipient who is admitted as an inpatient by a 20 licensed physician or dentist to a hospital licensed under 21 part I of chapter 395. However, the agency shall limit the 22 payment for inpatient hospital services for a Medicaid 23 recipient 21 years of age or older to 45 days or the number of 24 days specified in the annual necessary to comply with the 25 General Appropriations Act. 26 (a) The agency is authorized to implement 27 reimbursement and utilization management reforms in order to 28 comply with any limitations or directions in the General 29 Appropriations Act, which may include, but are not limited to: 30 prior authorization for inpatient psychiatric days; prior 31 authorization for nonemergency hospital inpatient admissions 13 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 for individuals 21 years of age and older; authorization of 2 emergency and urgent-care admissions within 24 hours after 3 admission; enhanced utilization and concurrent review programs 4 for highly utilized services; reduction or elimination of 5 covered days of service; adjusting reimbursement ceilings for 6 variable costs; adjusting reimbursement ceilings for fixed and 7 property costs; and implementing target rates of increase. The 8 agency may limit prior authorization for hospital inpatient 9 services to selected diagnosis-related groups, based on an 10 analysis of the cost and potential for unnecessary 11 hospitalizations represented by certain diagnoses. Admissions 12 for normal delivery and newborns are exempt from requirements 13 for prior authorization. In implementing the provisions of 14 this section related to prior authorization, the agency shall 15 ensure that the process for authorization is accessible 24 16 hours per day, 7 days per week and authorization is 17 automatically granted when not denied within 4 hours after the 18 request. Authorization procedures must include steps for 19 review of denials. Upon implementing the prior authorization 20 program for hospital inpatient services, the agency shall 21 discontinue its hospital retrospective review program. 22 (b) A licensed hospital maintained primarily for the 23 care and treatment of patients having mental disorders or 24 mental diseases is not eligible to participate in the hospital 25 inpatient portion of the Medicaid program except as provided 26 in federal law. However, subject to federal Medicaid waiver 27 approval, the agency may pay for the department shall apply 28 for a waiver, within 9 months after June 5, 1991, designed to 29 provide hospitalization services for mental health reasons to 30 children and adults in the most cost-effective and lowest cost 31 setting possible. Such waiver shall include a request for the 14 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 opportunity to pay for care in hospitals known under federal 2 law as "institutions for mental disease" or "IMD's." The 3 waiver proposal shall propose no additional aggregate cost to 4 the state or Federal Government, and shall be conducted in 5 Hillsborough County, Highlands County, Hardee County, Manatee 6 County, and Polk County. The waiver proposal may incorporate 7 competitive bidding for hospital services, comprehensive 8 brokering, prepaid capitated arrangements, or other mechanisms 9 deemed by the agency department to show promise in reducing 10 the cost of acute care and increasing the effectiveness of 11 preventive care. When developing The waiver proposal, the 12 department shall take into account price, quality, 13 accessibility, linkages of the hospital to community services 14 and family support programs, plans of the hospital to ensure 15 the earliest discharge possible, and the comprehensiveness of 16 the mental health and other health care services offered by 17 participating providers. 18 (c) The agency for Health Care Administration shall 19 adjust a hospital's current inpatient per diem rate to reflect 20 the cost of serving the Medicaid population at that 21 institution if: 22 1. The hospital experiences an increase in Medicaid 23 caseload by more than 25 percent in any year, primarily 24 resulting from the closure of a hospital in the same service 25 area occurring after July 1, 1995; 26 2. The hospital's Medicaid per diem rate is at least 27 25 percent below the Medicaid per patient cost for that year; 28 or 29 3. The hospital is located in a county that has five 30 or fewer hospitals, began offering obstetrical services on or 31 after September 1999, and has submitted a request in writing 15 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 to the agency for a rate adjustment after July 1, 2000, but 2 before September 30, 2000, in which case such hospital's 3 Medicaid inpatient per diem rate shall be adjusted to cost, 4 effective July 1, 2002. 5 6 No later than October 1 of each year, the agency must provide 7 estimated costs for any adjustment in a hospital inpatient per 8 diem pursuant to this paragraph to the Executive Office of the 9 Governor, the House of Representatives General Appropriations 10 Committee, and the Senate Appropriations Committee. Before the 11 agency implements a change in a hospital's inpatient per diem 12 rate pursuant to this paragraph, the Legislature must have 13 specifically appropriated sufficient funds in the General 14 Appropriations Act to support the increase in cost as 15 estimated by the agency. 16 (d) Effective September 1, 2004, the agency shall 17 implement a hospitalist program in certain high-volume 18 participating hospitals, in select counties or statewide. The 19 program shall require hospitalists to authorize and manage 20 Medicaid recipients' hospital admissions and lengths of stay. 21 Individuals who are dually eligible for Medicare and Medicaid 22 are exempted from this requirement. Medicaid participating 23 physicians and other practitioners with hospital admitting 24 privileges shall coordinate and review admissions of Medicaid 25 beneficiaries with the hospitalist. The agency may 26 competitively bid a contract for selection of a qualified 27 organization to provide hospitalist services. The agency may 28 seek federal waiver approval as necessary to implement this 29 policy. 30 (e) Effective November 1, 2004, the agency shall 31 implement a comprehensive utilization management program for 16 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 hospital neonatal intensive care stays in certain high-volume 2 Medicaid participating hospitals, in select counties or 3 statewide, and shall replace existing hospital inpatient 4 utilization management programs. The program shall be 5 designed to manage the lengths of stay for children being 6 treated in neonatal intensive care units and must seek the 7 earliest medically appropriate discharge to the child's home 8 or other less costly treatment setting. The agency may 9 competitively bid a contract for selection of a qualified 10 organization to provide neonatal intensive care utilization 11 management services. The agency may seek federal waiver 12 approval as necessary to implement this policy. 13 (6) HOSPITAL OUTPATIENT SERVICES.--The agency shall 14 pay for preventive, diagnostic, therapeutic, or palliative 15 care and other services provided to a recipient in the 16 outpatient portion of a hospital licensed under part I of 17 chapter 395, and provided under the direction of a licensed 18 physician or licensed dentist, except that payment for such 19 care and services is limited to $1,500 per state fiscal year 20 per recipient, unless an exception has been made by the 21 agency, and with the exception of a Medicaid recipient under 22 age 21, in which case the only limitation is medical 23 necessity. 24 (7) INDEPENDENT LABORATORY SERVICES.--The agency shall 25 pay for medically necessary diagnostic laboratory procedures 26 ordered by a licensed physician or other licensed practitioner 27 of the healing arts which are provided for a recipient in a 28 laboratory that meets the requirements for Medicare 29 participation and is licensed under chapter 483, if required. 30 (8) NURSING FACILITY SERVICES.--The agency shall pay 31 for 24-hour-a-day nursing and rehabilitative services for a 17 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 recipient in a nursing facility licensed under part II of 2 chapter 400 or in a rural hospital, as defined in s. 395.602, 3 or in a Medicare certified skilled nursing facility operated 4 by a hospital, as defined by s. 395.002(11), that is licensed 5 under part I of chapter 395, and in accordance with provisions 6 set forth in s. 409.908(2)(a), which services are ordered by 7 and provided under the direction of a licensed physician. 8 However, if a nursing facility has been destroyed or otherwise 9 made uninhabitable by natural disaster or other emergency and 10 another nursing facility is not available, the agency must pay 11 for similar services temporarily in a hospital licensed under 12 part I of chapter 395 provided federal funding is approved and 13 available. 14 (9) PHYSICIAN SERVICES.--The agency shall pay for 15 covered services and procedures rendered to a recipient by, or 16 under the personal supervision of, a person licensed under 17 state law to practice medicine or osteopathic medicine. These 18 services may be furnished in the physician's office, the 19 Medicaid recipient's home, a hospital, a nursing facility, or 20 elsewhere, but shall be medically necessary for the treatment 21 of an injury, illness, or disease within the scope of the 22 practice of medicine or osteopathic medicine as defined by 23 state law. The agency shall not pay for services that are 24 clinically unproven, experimental, or for purely cosmetic 25 purposes. 26 (10) PORTABLE X-RAY SERVICES.--The agency shall pay 27 for professional and technical portable radiological services 28 ordered by a licensed physician or other licensed practitioner 29 of the healing arts which are provided by a licensed 30 professional in a setting other than a hospital, clinic, or 31 office of a physician or practitioner of the healing arts, on 18 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 behalf of a recipient. 2 (11) RURAL HEALTH CLINIC SERVICES.--The agency shall 3 pay for outpatient primary health care services for a 4 recipient provided by a clinic certified by and participating 5 in the Medicare program which is located in a federally 6 designated, rural, medically underserved area and has on its 7 staff one or more licensed primary care nurse practitioners or 8 physician assistants, and a licensed staff supervising 9 physician or a consulting supervising physician. 10 (12) TRANSPORTATION SERVICES.--The agency shall ensure 11 that appropriate transportation services are available for a 12 Medicaid recipient in need of transport to a qualified 13 Medicaid provider for medically necessary and 14 Medicaid-compensable services, provided a recipient's client's 15 ability to choose a specific transportation provider is shall 16 be limited to those options resulting from policies 17 established by the agency to meet the fiscal limitations of 18 the General Appropriations Act. Effective January 1, 2005, 19 except for persons who meet Medicaid disability standards 20 adopted by rule, nonemergency transportation services may not 21 be offered to nondisabled recipients if public transportation 22 is generally available in the beneficiary's community. The 23 agency may pay for transportation and other related travel 24 expenses as necessary only if these services are not otherwise 25 available. The agency may competitively bid and contract with 26 a statewide vendor on a capitated basis for the provision of 27 nonemergency transportation services. The agency may seek 28 federal waiver approval as necessary to implement this 29 subsection. 30 Section 7. Subsections (13), (14), and (15) of section 31 409.906, Florida Statutes, are amended to read: 19 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 409.906 Optional Medicaid services.--Subject to 2 specific appropriations, the agency may make payments for 3 services which are optional to the state under Title XIX of 4 the Social Security Act and are furnished by Medicaid 5 providers to recipients who are determined to be eligible on 6 the dates on which the services were provided. Any optional 7 service that is provided shall be provided only when medically 8 necessary and in accordance with state and federal law. 9 Optional services rendered by providers in mobile units to 10 Medicaid recipients may be restricted or prohibited by the 11 agency. Nothing in this section shall be construed to prevent 12 or limit the agency from adjusting fees, reimbursement rates, 13 lengths of stay, number of visits, or number of services, or 14 making any other adjustments necessary to comply with the 15 availability of moneys and any limitations or directions 16 provided for in the General Appropriations Act or chapter 216. 17 If necessary to safeguard the state's systems of providing 18 services to elderly and disabled persons and subject to the 19 notice and review provisions of s. 216.177, the Governor may 20 direct the Agency for Health Care Administration to amend the 21 Medicaid state plan to delete the optional Medicaid service 22 known as "Intermediate Care Facilities for the Developmentally 23 Disabled." Optional services may include: 24 (13) HOME AND COMMUNITY-BASED SERVICES.--The agency 25 may pay for home-based or community-based services that are 26 rendered to a recipient in accordance with a federally 27 approved waiver program. 28 (a) The agency may limit or eliminate coverage for 29 certain Project AIDS Care Waiver services, preauthorize 30 high-cost or highly utilized services, or make any other 31 adjustments necessary to comply with any limitations or 20 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 directions provided for in the General Appropriations Act. 2 (b) The agency may consolidate types of services 3 offered in the Aged and Disabled Waiver, the Channeling 4 Waiver, Project AIDS Care Waiver, and the Traumatic Brain and 5 Spinal Cord Injury Waiver programs in order to group similar 6 services under a single service, or upon evidence of the need 7 for including a particular service type in a particular 8 waiver. The agency may seek federal waiver approval as 9 necessary to implement this policy. 10 (c) The agency may implement a utilization management 11 program designed to preauthorize home-and-community-based 12 service plans, including, but not limited to, proposed 13 quantity and duration of services, and to monitor ongoing 14 service use by participants in the program. The agency may 15 competitively procure a qualified organization to provide 16 utilization management of home-and-community-based services. 17 The agency may seek federal waiver approval as necessary to 18 implement this policy. 19 (14) HOSPICE CARE SERVICES.--The agency may pay for 20 all reasonable and necessary services for the palliation or 21 management of a recipient's terminal illness, if the services 22 are provided by a hospice that is licensed under part VI of 23 chapter 400 and meets Medicare certification requirements. 24 Effective October 1, 2004, subject to federal approval, the 25 community hospice income standard would be equal to the level 26 set in s. 409.904(1). 27 (15) INTERMEDIATE CARE FACILITY FOR THE 28 DEVELOPMENTALLY DISABLED SERVICES.--The agency may pay for 29 health-related care and services provided on a 24-hour-a-day 30 basis by a facility licensed and certified as a Medicaid 31 Intermediate Care Facility for the Developmentally Disabled, 21 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 for a recipient who needs such care because of a developmental 2 disability. 3 Section 8. Present subsection (8) of section 409.9065, 4 Florida Statutes, is redesignated as subsection (9), and a new 5 subsection (8) is added to that section, to read: 6 409.9065 Pharmaceutical expense assistance.-- 7 (8) In the absence of state appropriations for the 8 expansion of the Lifesaver Rx Program to provide benefits to 9 higher income groups and additional discounts as described in 10 subsections (2) and (3), the Agency for Health Care 11 Administration may, subject to federal approval and continuing 12 state appropriations, operate a pharmaceutical expense 13 assistance program that limits eligibility and benefits to 14 Medicaid beneficiaries who do not normally receive Medicaid 15 benefits, are Florida residents age 65 and older, have an 16 income less than or equal to 120 percent of the federal 17 poverty level, are eligible for Medicare, and request to be 18 enrolled in the program. Benefits under the limited 19 pharmaceutical expense assistance program shall include 20 Medicaid payment for up to $160 per month for prescribed 21 drugs, subject to benefit utilization controls applied to 22 other Medicaid prescribed drug benefits and the following 23 copayments: $2 per generic product, $5 for a product that is 24 on the Medicaid Preferred Drug List, and $15 for a product 25 that is not on the Preferred Drug List. 26 Section 9. Subsection (12) is added to section 27 409.907, Florida Statutes, to read: 28 409.907 Medicaid provider agreements.--The agency may 29 make payments for medical assistance and related services 30 rendered to Medicaid recipients only to an individual or 31 entity who has a provider agreement in effect with the agency, 22 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 who is performing services or supplying goods in accordance 2 with federal, state, and local law, and who agrees that no 3 person shall, on the grounds of handicap, race, color, or 4 national origin, or for any other reason, be subjected to 5 discrimination under any program or activity for which the 6 provider receives payment from the agency. 7 (12) Licensed, certified, or otherwise qualified 8 providers are not entitled to enrollment in a Medicaid 9 provider network. 10 Section 10. Subsection (9) is added to section 11 409.911, Florida Statutes, to read: 12 409.911 Disproportionate share program.--Subject to 13 specific allocations established within the General 14 Appropriations Act and any limitations established pursuant to 15 chapter 216, the agency shall distribute, pursuant to this 16 section, moneys to hospitals providing a disproportionate 17 share of Medicaid or charity care services by making quarterly 18 Medicaid payments as required. Notwithstanding the provisions 19 of s. 409.915, counties are exempt from contributing toward 20 the cost of this special reimbursement for hospitals serving a 21 disproportionate share of low-income patients. 22 (9) The Agency for Health Care Administration shall 23 convene a Medicaid Disproportionate Share Council. 24 (a) The purpose of the council is to study and make 25 recommendations regarding: 26 1. The formula for the regular disproportionate share 27 program and alternative financing options; 28 2. Enhanced Medicaid funding through the Special 29 Medicaid Payment program; and 30 3. The federal status of the upper-payment-limit 31 funding option and how this option may be used to promote 23 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 health care initiatives determined by the council to be state 2 health care priorities. 3 (b) The council shall include representatives of the 4 Executive Office of the Governor and of the agency, 5 representatives from teaching, public, private nonprofit, 6 private for-profit, and family practice teaching hospitals, 7 and representatives from other groups as needed. 8 (c) The council shall submit its findings and 9 recommendations to the Governor and the Legislature no later 10 than February 1 of each year. 11 Section 11. Subsection (40) of section 409.912, 12 Florida Statutes, is amended, and subsection (45) is added to 13 that section, to read: 14 409.912 Cost-effective purchasing of health care.--The 15 agency shall purchase goods and services for Medicaid 16 recipients in the most cost-effective manner consistent with 17 the delivery of quality medical care. The agency shall 18 maximize the use of prepaid per capita and prepaid aggregate 19 fixed-sum basis services when appropriate and other 20 alternative service delivery and reimbursement methodologies, 21 including competitive bidding pursuant to s. 287.057, designed 22 to facilitate the cost-effective purchase of a case-managed 23 continuum of care. The agency shall also require providers to 24 minimize the exposure of recipients to the need for acute 25 inpatient, custodial, and other institutional care and the 26 inappropriate or unnecessary use of high-cost services. The 27 agency may establish prior authorization requirements for 28 certain populations of Medicaid beneficiaries, certain drug 29 classes, or particular drugs to prevent fraud, abuse, overuse, 30 and possible dangerous drug interactions. The Pharmaceutical 31 and Therapeutics Committee shall make recommendations to the 24 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 agency on drugs for which prior authorization is required. The 2 agency shall inform the Pharmaceutical and Therapeutics 3 Committee of its decisions regarding drugs subject to prior 4 authorization. 5 (40)(a) The agency shall implement a Medicaid 6 prescribed-drug spending-control program that includes the 7 following components: 8 1. Medicaid prescribed-drug coverage for brand-name 9 drugs for adult Medicaid recipients is limited to the 10 dispensing of four brand-name drugs per month per recipient. 11 Children are exempt from this restriction. Antiretroviral 12 agents are excluded from this limitation. No requirements for 13 prior authorization or other restrictions on medications used 14 to treat mental illnesses such as schizophrenia, severe 15 depression, or bipolar disorder may be imposed on Medicaid 16 recipients. Medications that will be available without 17 restriction for persons with mental illnesses include atypical 18 antipsychotic medications, conventional antipsychotic 19 medications, selective serotonin reuptake inhibitors, and 20 other medications used for the treatment of serious mental 21 illnesses. The agency shall also limit the amount of a 22 prescribed drug dispensed to no more than a 34-day supply. The 23 agency shall continue to provide unlimited generic drugs, 24 contraceptive drugs and items, and diabetic supplies. Although 25 a drug may be included on the preferred drug formulary, it 26 would not be exempt from the four-brand limit. The agency may 27 authorize exceptions to the brand-name-drug restriction based 28 upon the treatment needs of the patients, only when such 29 exceptions are based on prior consultation provided by the 30 agency or an agency contractor, but the agency must establish 31 procedures to ensure that: 25 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 a. There will be a response to a request for prior 2 consultation by telephone or other telecommunication device 3 within 24 hours after receipt of a request for prior 4 consultation; 5 b. A 72-hour supply of the drug prescribed will be 6 provided in an emergency or when the agency does not provide a 7 response within 24 hours as required by sub-subparagraph a.; 8 and 9 c. Except for the exception for nursing home residents 10 and other institutionalized adults and except for drugs on the 11 restricted formulary for which prior authorization may be 12 sought by an institutional or community pharmacy, prior 13 authorization for an exception to the brand-name-drug 14 restriction is sought by the prescriber and not by the 15 pharmacy. When prior authorization is granted for a patient in 16 an institutional setting beyond the brand-name-drug 17 restriction, such approval is authorized for 12 months and 18 monthly prior authorization is not required for that patient. 19 2. Reimbursement to pharmacies for Medicaid prescribed 20 drugs shall be set at the average wholesale price less 14.25 21 13.25 percent or wholesale acquisition cost plus 5 percent, 22 whichever is less. 23 3. The agency shall develop and implement a process 24 for managing the drug therapies of Medicaid recipients who are 25 using significant numbers of prescribed drugs each month. The 26 management process may include, but is not limited to, 27 comprehensive, physician-directed medical-record reviews, 28 claims analyses, and case evaluations to determine the medical 29 necessity and appropriateness of a patient's treatment plan 30 and drug therapies. The agency may contract with a private 31 organization to provide drug-program-management services. The 26 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 Medicaid drug benefit management program shall include 2 initiatives to manage drug therapies for HIV/AIDS patients, 3 patients using 20 or more unique prescriptions in a 180-day 4 period, and the top 1,000 patients in annual spending. 5 4. The agency may limit the size of its pharmacy 6 network based on need, competitive bidding, price 7 negotiations, credentialing, or similar criteria. The agency 8 shall give special consideration to rural areas in determining 9 the size and location of pharmacies included in the Medicaid 10 pharmacy network. A pharmacy credentialing process may include 11 criteria such as a pharmacy's full-service status, location, 12 size, patient educational programs, patient consultation, 13 disease-management services, and other characteristics. The 14 agency may impose a moratorium on Medicaid pharmacy enrollment 15 when it is determined that it has a sufficient number of 16 Medicaid-participating providers. 17 5. The agency shall develop and implement a program 18 that requires Medicaid practitioners who prescribe drugs to 19 use a counterfeit-proof prescription pad for Medicaid 20 prescriptions. The agency shall require the use of 21 standardized counterfeit-proof prescription pads by 22 Medicaid-participating prescribers or prescribers who write 23 prescriptions for Medicaid recipients. The agency may 24 implement the program in targeted geographic areas or 25 statewide. 26 6. The agency may enter into arrangements that require 27 manufacturers of generic drugs prescribed to Medicaid 28 recipients to provide rebates of at least 15.1 percent of the 29 average manufacturer price for the manufacturer's generic 30 products. These arrangements shall require that if a 31 generic-drug manufacturer pays federal rebates for 27 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 Medicaid-reimbursed drugs at a level below 15.1 percent, the 2 manufacturer must provide a supplemental rebate to the state 3 in an amount necessary to achieve a 15.1-percent rebate level. 4 7. The agency may establish a preferred drug formulary 5 in accordance with 42 U.S.C. s. 1396r-8, and, pursuant to the 6 establishment of such formulary, it is authorized to negotiate 7 supplemental rebates from manufacturers that are in addition 8 to those required by Title XIX of the Social Security Act and 9 at no less than 12 10 percent of the average manufacturer 10 price as defined in 42 U.S.C. s. 1936 on the last day of a 11 quarter unless the federal or supplemental rebate, or both, 12 equals or exceeds 27 25 percent. There is no upper limit on 13 the supplemental rebates the agency may negotiate. The agency 14 may determine that specific products, brand-name or generic, 15 are competitive at lower rebate percentages. Agreement to pay 16 the minimum supplemental rebate percentage will guarantee a 17 manufacturer that the Medicaid Pharmaceutical and Therapeutics 18 Committee will consider a product for inclusion on the 19 preferred drug formulary. However, a pharmaceutical 20 manufacturer is not guaranteed placement on the formulary by 21 simply paying the minimum supplemental rebate. Agency 22 decisions will be made on the clinical efficacy of a drug and 23 recommendations of the Medicaid Pharmaceutical and 24 Therapeutics Committee, as well as the price of competing 25 products minus federal and state rebates. The agency is 26 authorized to contract with an outside agency or contractor to 27 conduct negotiations for supplemental rebates. For the 28 purposes of this section, the term "supplemental rebates" may 29 include, at the agency's discretion, cash rebates and other 30 program benefits that offset a Medicaid expenditure. Such 31 other program benefits may include, but are not limited to, 28 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 disease management programs, drug product donation programs, 2 drug utilization control programs, prescriber and beneficiary 3 counseling and education, fraud and abuse initiatives, and 4 other services or administrative investments with guaranteed 5 savings to the Medicaid program in the same year the rebate 6 reduction is included in the General Appropriations Act. The 7 agency is authorized to seek any federal waivers necessary to 8 implement this initiative. 9 8. The agency shall implement a return and reuse 10 program for drugs dispensed by pharmacies to institutional 11 recipients, which includes payment of a $5 restocking fee for 12 the implementation and operation of the program. The return 13 and reuse program shall be implemented electronically and in a 14 manner that promotes efficiency. The program must permit a 15 pharmacy to exclude drugs from the program if it is not 16 practical or cost-effective for the drug to be included and 17 must provide for the return to inventory of drugs that cannot 18 be credited or returned in a cost-effective manner. The agency 19 shall establish an advisory committee for the purposes of 20 studying the feasibility of using a restricted drug formulary 21 for nursing home residents and other institutionalized adults. 22 The committee shall be comprised of seven members appointed by 23 the Secretary of Health Care Administration. The committee 24 members shall include two physicians licensed under chapter 25 458 or chapter 459; three pharmacists licensed under chapter 26 465 and appointed from a list of recommendations provided by 27 the Florida Long-Term Care Pharmacy Alliance; and two 28 pharmacists licensed under chapter 465. 29 9. The agency for Health Care Administration shall 30 expand home delivery of pharmacy products. To assist Medicaid 31 patients in securing their prescriptions and reduce program 29 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 costs, the agency shall expand its current mail-order-pharmacy 2 diabetes-supply program to include all generic and brand-name 3 drugs used by Medicaid patients with diabetes. Medicaid 4 recipients in the current program may obtain nondiabetes drugs 5 on a voluntary basis. This initiative is limited to the 6 geographic area covered by the current contract. The agency 7 may seek and implement any federal waivers necessary to 8 implement this subparagraph. 9 10. The agency shall implement a 10 utilization-management and prior-authorization program for 11 COX-II selective inhibitor products. The program shall use 12 evidence-based therapy management guidelines to ensure medical 13 necessity and appropriate prescribing of COX-II products 14 versus conventional nonsteroidal anti-inflammatory agents 15 (NSAIDS) in the absence of contraindications regardless of 16 preferred drug list status. The agency may seek federal 17 waiver approval as necessary to implement this policy. 18 11. The agency shall limit to one dose per month any 19 drug prescribed for the purpose of enhancing or enabling 20 sexual performance. The agency may seek federal waiver 21 approval as necessary to implement this policy. 22 12. The agency may specify the preferred daily dosing 23 form or strength for the purpose of promoting best practices 24 with regard to the prescribing of certain drugs and ensuring 25 cost-effective prescribing practices. 26 13. The agency may require prior authorization for the 27 off-label use of Medicaid-covered prescribed drugs. The 28 agency may, but is not required to, preauthorize the use of a 29 product for an indication not in the approved labeling. Prior 30 authorization may require the prescribing professional to 31 provide information about the rationale and supporting medical 30 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 evidence for the off-label use of a drug. 2 14. The agency may adopt an algorithm-driven treatment 3 protocol for major psychiatric disorders, including, at a 4 minimum, schizophrenia, major depressive disorders, and 5 bipolar disorder. The purpose of the algorithms is to improve 6 the quality of care, achieve the best possible patient 7 outcomes, and ensure cost-effective management of the use of 8 medications. The medication program shall use evidence-based, 9 consensus medication treatment algorithms, clinical and 10 technical support necessary to aid clinician implementation of 11 the algorithm, patient and family education programs to ensure 12 that the patient is an active partner in care, and the uniform 13 documentation of care provided and patient outcomes achieved. 14 The agency shall coordinate the development and adoption of 15 medication algorithms with the Department of Children and 16 Family Services. The agency may seek any federal waivers 17 necessary to implement this program. 18 15. The agency shall implement a Medicaid behavioral 19 health drug management program financed through a value-added 20 agreement with pharmaceutical manufacturers that provide 21 financing for program startup and operational costs and 22 guarantee Medicaid budget savings. The agency shall contract 23 for the implementation of this program with vendors that have 24 an established relationship with pharmaceutical manufacturers 25 providing grant funds and experience in operating behavioral 26 health drug management programs. The agency, in conjunction 27 with the Department of Children and Family Services, shall 28 implement the Medicaid behavioral health drug management 29 system that is designed to improve the quality of care and 30 behavioral health prescribing practices based on best-practice 31 guidelines, improve patient adherence to medication plans, 31 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 reduce clinical risk, and lower prescribed drug costs and the 2 rate of inappropriate spending on Medicaid behavioral drugs. 3 The program must: 4 a. Provide for the development and adoption of 5 best-practice guidelines for behavioral-health-related drugs, 6 such as antipsychotics, antidepressants, and medications for 7 treating bipolar disorders and other behavioral conditions, 8 and translate them into practice; review behavioral health 9 prescribers and compare their prescribing patterns to a number 10 of indicators that are based on national standards; and 11 determine deviations from best-practice guidelines; 12 b. Implement processes for providing feedback to and 13 educating prescribers using best-practice educational 14 materials and peer-to-peer consultation; 15 c. Assess Medicaid beneficiaries who are outliers in 16 their use of behavioral health drugs with regard to the 17 numbers and types of drugs taken, drug dosages, combination 18 drug therapies, and other indicators of improper use of 19 behavioral health drugs; 20 d. Alert prescribers to patients who fail to refill 21 prescriptions in a timely fashion, are prescribed multiple 22 same-class behavioral health drugs, and may have other 23 potential medication problems; 24 e. Track spending trends for behavioral health drugs 25 and deviation from best-practice guidelines; 26 f. Use educational and technological approaches to 27 promote best practices; educate consumers; and train 28 prescribers in the use of practice guidelines; 29 g. Disseminate electronic and published materials; 30 h. Hold statewide and regional conferences; and 31 i. Implement a disease-management program with a model 32 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 quality-based medication component for severely mentally ill 2 individuals and emotionally disturbed children who are high 3 users of care. 4 5 If the agency is unable to negotiate a contract with one or 6 more manufacturers to finance and guarantee savings associated 7 with a behavioral health drug management program by July 30, 8 2004, the four-brand drug limit and preferred drug list 9 prior-authorization requirements shall apply to 10 mental-health-related drugs, notwithstanding any provision in 11 subparagraph 1. 12 (b) The agency shall implement this subsection to the 13 extent that funds are appropriated to administer the Medicaid 14 prescribed-drug spending-control program. The agency may 15 contract all or any part or all of this program, including the 16 overall management of the drug program, to private 17 organizations. 18 (c) The agency shall submit quarterly reports to the 19 Governor, the President of the Senate, and the Speaker of the 20 House of Representatives which must include, but need not be 21 limited to, the progress made in implementing this subsection 22 and its effect on Medicaid prescribed-drug expenditures. 23 (45) The agency may implement Medicaid fee-for-service 24 provider network controls, including, but not limited to, 25 provider credentialing. If a credentialing process is used, 26 the agency may limit its network based upon the following 27 considerations: 28 (a) Beneficiary access to care; 29 (b) Provider availability; 30 (c) Provider quality standards; 31 (d) Cultural competency; 33 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 (e) Demographic characteristics of beneficiaries; 2 (f) Practice standards; 3 (g) Service wait times; 4 (h) Usage criteria; 5 (i) Provider turnover; 6 (j) Provider profiling; 7 (k) Provider license history; 8 (l) History of fraud and abuse findings; 9 (m) Peer review; 10 (n) Policy and billing infractions; 11 (o) Clinical and medical record audit findings; and 12 (p) Such other findings as the agency considers 13 necessary to ensure the integrity of the program. 14 Section 12. Subsection (2) of section 409.9122, 15 Florida Statutes, is amended, and subsection (14) is added to 16 that section, to read: 17 409.9122 Mandatory Medicaid managed care enrollment; 18 programs and procedures.-- 19 (2)(a) The agency shall enroll in a managed care plan 20 or MediPass all Medicaid recipients, except those Medicaid 21 recipients who are: in an institution; enrolled in the 22 Medicaid medically needy program; or eligible for both 23 Medicaid and Medicare. However, to the extent permitted by 24 federal law, the agency may enroll in a managed care plan or 25 MediPass a Medicaid recipient who is exempt from mandatory 26 managed care enrollment, provided that: 27 1. The recipient's decision to enroll in a managed 28 care plan or MediPass is voluntary; 29 2. If the recipient chooses to enroll in a managed 30 care plan, the agency has determined that the managed care 31 plan provides specific programs and services which address the 34 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 special health needs of the recipient; and 2 3. The agency receives any necessary waivers from the 3 federal Health Care Financing Administration. 4 5 The agency shall develop rules to establish policies by which 6 exceptions to the mandatory managed care enrollment 7 requirement may be made on a case-by-case basis. The rules 8 shall include the specific criteria to be applied when making 9 a determination as to whether to exempt a recipient from 10 mandatory enrollment in a managed care plan or MediPass. 11 School districts participating in the certified school match 12 program pursuant to ss. 409.908(21) and 1011.70 shall be 13 reimbursed by Medicaid, subject to the limitations of s. 14 1011.70(1), for a Medicaid-eligible child participating in the 15 services as authorized in s. 1011.70, as provided for in s. 16 409.9071, regardless of whether the child is enrolled in 17 MediPass or a managed care plan. Managed care plans shall make 18 a good faith effort to execute agreements with school 19 districts regarding the coordinated provision of services 20 authorized under s. 1011.70. County health departments 21 delivering school-based services pursuant to ss. 381.0056 and 22 381.0057 shall be reimbursed by Medicaid for the federal share 23 for a Medicaid-eligible child who receives Medicaid-covered 24 services in a school setting, regardless of whether the child 25 is enrolled in MediPass or a managed care plan. Managed care 26 plans shall make a good faith effort to execute agreements 27 with county health departments regarding the coordinated 28 provision of services to a Medicaid-eligible child. To ensure 29 continuity of care for Medicaid patients, the agency, the 30 Department of Health, and the Department of Education shall 31 develop procedures for ensuring that a student's managed care 35 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 plan or MediPass provider receives information relating to 2 services provided in accordance with ss. 381.0056, 381.0057, 3 409.9071, and 1011.70. 4 (b) A Medicaid recipient shall not be enrolled in or 5 assigned to a managed care plan or MediPass unless the managed 6 care plan or MediPass has complied with the quality-of-care 7 standards specified in paragraphs (3)(a) and (b), 8 respectively. 9 (c) Medicaid recipients shall have a choice of managed 10 care plans or MediPass. The Agency for Health Care 11 Administration, the Department of Health, the Department of 12 Children and Family Services, and the Department of Elderly 13 Affairs shall cooperate to ensure that each Medicaid recipient 14 receives clear and easily understandable information that 15 meets the following requirements: 16 1. Explains the concept of managed care, including 17 MediPass. 18 2. Provides information on the comparative performance 19 of managed care plans and MediPass in the areas of quality, 20 credentialing, preventive health programs, network size and 21 availability, and patient satisfaction. 22 3. Explains where additional information on each 23 managed care plan and MediPass in the recipient's area can be 24 obtained. 25 4. Explains that recipients have the right to choose 26 their own managed care plans or MediPass. However, if a 27 recipient does not choose a managed care plan or MediPass, the 28 agency will assign the recipient to a managed care plan or 29 MediPass according to the criteria specified in this section. 30 5. Explains the recipient's right to complain, file a 31 grievance, or change managed care plans or MediPass providers 36 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 if the recipient is not satisfied with the managed care plan 2 or MediPass. 3 (d) The agency shall develop a mechanism for providing 4 information to Medicaid recipients for the purpose of making a 5 managed care plan or MediPass selection. Examples of such 6 mechanisms may include, but not be limited to, interactive 7 information systems, mailings, and mass marketing materials. 8 Managed care plans and MediPass providers are prohibited from 9 providing inducements to Medicaid recipients to select their 10 plans or from prejudicing Medicaid recipients against other 11 managed care plans or MediPass providers. 12 (e) Medicaid recipients who are already enrolled in a 13 managed care plan or MediPass shall be offered the opportunity 14 to change managed care plans or MediPass providers on a 15 staggered basis, as defined by the agency. All Medicaid 16 recipients shall have 90 days in which to make a choice of 17 managed care plans or MediPass providers. Those Medicaid 18 recipients who do not make a choice shall be assigned to a 19 managed care plan or MediPass in accordance with paragraph 20 (f). To facilitate continuity of care, for a Medicaid 21 recipient who is also a recipient of Supplemental Security 22 Income (SSI), prior to assigning the SSI recipient to a 23 managed care plan or MediPass, the agency shall determine 24 whether the SSI recipient has an ongoing relationship with a 25 MediPass provider or managed care plan, and if so, the agency 26 shall assign the SSI recipient to that MediPass provider or 27 managed care plan. Those SSI recipients who do not have such a 28 provider relationship shall be assigned to a managed care plan 29 or MediPass provider in accordance with paragraph (f). 30 (f) When a Medicaid recipient does not choose a 31 managed care plan or MediPass provider, the agency shall 37 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 assign the Medicaid recipient to a managed care plan or 2 MediPass provider. Medicaid recipients who are subject to 3 mandatory assignment but who fail to make a choice shall be 4 assigned to managed care plans until an enrollment of 39 40 5 percent in MediPass and 61 60 percent in managed care plans is 6 achieved. Once this enrollment is achieved, the assignments of 7 recipients who fail to make a choice shall be divided in order 8 to maintain an enrollment in MediPass and managed care plans 9 which is in a 39 40 percent and 61 60 percent proportion, 10 respectively. Thereafter, assignment of Medicaid recipients 11 who fail to make a choice shall be based proportionally on the 12 preferences of recipients who have made a choice in the 13 previous period. Such proportions shall be revised at least 14 quarterly to reflect an update of the preferences of Medicaid 15 recipients. The agency shall disproportionately assign 16 Medicaid-eligible recipients who are required to but have 17 failed to make a choice of managed care plan or MediPass, 18 including children, and who are to be assigned to the MediPass 19 program to children's networks as described in s. 20 409.912(3)(g), Children's Medical Services network as defined 21 in s. 391.021, exclusive provider organizations, provider 22 service networks, minority physician networks, and pediatric 23 emergency department diversion programs authorized by this 24 chapter or the General Appropriations Act, in such manner as 25 the agency deems appropriate, until the agency has determined 26 that the networks and programs have sufficient numbers to be 27 economically operated. For purposes of this paragraph, when 28 referring to assignment, the term "managed care plans" 29 includes health maintenance organizations, exclusive provider 30 organizations, provider service networks, minority physician 31 networks, Children's Medical Services network, and pediatric 38 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 emergency department diversion programs authorized by this 2 chapter or the General Appropriations Act. When making 3 assignments, the agency shall take into account the following 4 criteria and considerations: 5 1. A managed care plan has sufficient network capacity 6 to meet the need of members. 7 2. The managed care plan or MediPass has previously 8 enrolled the recipient as a member, or one of the managed care 9 plan's primary care providers or MediPass providers has 10 previously provided health care to the recipient. 11 3. The agency has knowledge that the member has 12 previously expressed a preference for a particular managed 13 care plan or MediPass provider as indicated by Medicaid 14 fee-for-service claims data, but has failed to make a choice. 15 4. The managed care plan's or MediPass primary care 16 providers are geographically accessible to the recipient's 17 residence. 18 19 (g) When more than one managed care plan or MediPass provider 20 meets the criteria specified in this paragraph (f), the agency 21 shall make recipient assignments consecutively by family unit. 22 (g)(h) The agency may not engage in practices that are 23 designed to favor one managed care plan over another or that 24 are designed to influence Medicaid recipients to enroll in 25 MediPass rather than in a managed care plan or to enroll in a 26 managed care plan rather than in MediPass. This subsection 27 does not prohibit the agency from reporting on the performance 28 of MediPass or any managed care plan, as measured by 29 performance criteria developed by the agency. 30 (h) Effective January 1, 2005, the agency and the 31 Department of Children and Family Services shall ensure that 39 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 applicants for Medicaid for categories of assistance that 2 require eligible applicants to enroll in managed care shall 3 choose or be assigned to a managed care plan prior to an 4 eligibility start date so that enrollment in a managed care 5 plan begins on the same day as the eligibility start date. 6 (i) After a recipient has made a selection or has been 7 enrolled in a managed care plan or MediPass, the recipient 8 shall have 90 days in which to voluntarily disenroll and 9 select another managed care plan or MediPass provider. After 10 90 days, no further changes may be made except for cause. 11 Cause shall include, but not be limited to, poor quality of 12 care, lack of access to necessary specialty services, an 13 unreasonable delay or denial of service, or fraudulent 14 enrollment. The agency shall develop criteria for good cause 15 disenrollment for chronically ill and disabled populations who 16 are assigned to managed care plans if more appropriate care is 17 available through the MediPass program. The agency must make 18 a determination as to whether cause exists. However, the 19 agency may require a recipient to use the managed care plan's 20 or MediPass grievance process prior to the agency's 21 determination of cause, except in cases in which immediate 22 risk of permanent damage to the recipient's health is alleged. 23 The grievance process, when utilized, must be completed in 24 time to permit the recipient to disenroll no later than the 25 first day of the second month after the month the 26 disenrollment request was made. If the managed care plan or 27 MediPass, as a result of the grievance process, approves an 28 enrollee's request to disenroll, the agency is not required to 29 make a determination in the case. The agency must make a 30 determination and take final action on a recipient's request 31 so that disenrollment occurs no later than the first day of 40 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 the second month after the month the request was made. If the 2 agency fails to act within the specified timeframe, the 3 recipient's request to disenroll is deemed to be approved as 4 of the date agency action was required. Recipients who 5 disagree with the agency's finding that cause does not exist 6 for disenrollment shall be advised of their right to pursue a 7 Medicaid fair hearing to dispute the agency's finding. 8 (j) The agency shall apply for a federal waiver from 9 the Health Care Financing Administration to lock eligible 10 Medicaid recipients into a managed care plan or MediPass for 11 12 months after an open enrollment period. After 12 months' 12 enrollment, a recipient may select another managed care plan 13 or MediPass provider. However, nothing shall prevent a 14 Medicaid recipient from changing primary care providers within 15 the managed care plan or MediPass program during the 12-month 16 period. 17 (k) When a Medicaid recipient does not choose a 18 managed care plan or MediPass provider, the agency shall 19 assign the Medicaid recipient to a managed care plan, except 20 in those counties in which there are fewer than two managed 21 care plans accepting Medicaid enrollees, in which case 22 assignment shall be to a managed care plan or a MediPass 23 provider. Medicaid recipients in counties with fewer than two 24 managed care plans accepting Medicaid enrollees who are 25 subject to mandatory assignment but who fail to make a choice 26 shall be assigned to managed care plans until an enrollment of 27 39 40 percent in MediPass and 61 60 percent in managed care 28 plans is achieved. Once that enrollment is achieved, the 29 assignments shall be divided in order to maintain an 30 enrollment in MediPass and managed care plans which is in a 39 31 40 percent and 61 60 percent proportion, respectively. In 41 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 geographic areas where the agency is contracting for the 2 provision of comprehensive behavioral health services through 3 a capitated prepaid arrangement, recipients who fail to make a 4 choice shall be assigned equally to MediPass or a managed care 5 plan. For purposes of this paragraph, when referring to 6 assignment, the term "managed care plans" includes exclusive 7 provider organizations, provider service networks, Children's 8 Medical Services network, minority physician networks, and 9 pediatric emergency department diversion programs authorized 10 by this chapter or the General Appropriations Act. When making 11 assignments, the agency shall take into account the following 12 criteria: 13 1. A managed care plan has sufficient network capacity 14 to meet the need of members. 15 2. The managed care plan or MediPass has previously 16 enrolled the recipient as a member, or one of the managed care 17 plan's primary care providers or MediPass providers has 18 previously provided health care to the recipient. 19 3. The agency has knowledge that the member has 20 previously expressed a preference for a particular managed 21 care plan or MediPass provider as indicated by Medicaid 22 fee-for-service claims data, but has failed to make a choice. 23 4. The managed care plan's or MediPass primary care 24 providers are geographically accessible to the recipient's 25 residence. 26 5. The agency has authority to make mandatory 27 assignments based on quality of service and performance of 28 managed care plans. 29 (l) Notwithstanding the provisions of chapter 287, the 30 agency may, at its discretion, renew cost-effective contracts 31 for choice counseling services once or more for such periods 42 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 as the agency may decide. However, all such renewals may not 2 combine to exceed a total period longer than the term of the 3 original contract. 4 (14) The agency shall include in its calculation of 5 the hospital inpatient component of a Medicaid health 6 maintenance organization's capitation rate any special 7 payments, including, but not limited to, upper payment limit 8 or disproportionate share hospital payments, made to 9 qualifying hospitals through the fee-for-service program. The 10 agency may seek federal waiver approval as needed to implement 11 this adjustment. 12 Section 13. Paragraph (b) of subsection (1) of section 13 430.204, Florida Statutes, is amended to read: 14 430.204 Community-care-for-the-elderly core services; 15 departmental powers and duties.-- 16 (1) 17 (b) For fiscal year 2003-2004 only, The department 18 shall fund, through each area agency on aging in each county 19 as defined in s. 125.011(1), more than one community care 20 service system the primary purpose of which is the prevention 21 of unnecessary institutionalization of functionally impaired 22 elderly persons through the provision of community-based core 23 services. This paragraph expires July 1, 2004. 24 Section 14. Paragraph (b) of subsection (1) of section 25 430.205, Florida Statutes, is amended to read: 26 430.205 Community care service system.-- 27 (1) 28 (b) For fiscal year 2003-2004 only, The department 29 shall fund, through the area agency on aging in each county as 30 defined in s. 125.011(1), more than one community care service 31 system that provides case management and other in-home and 43 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 community services as needed to help elderly persons maintain 2 independence and prevent or delay more costly institutional 3 care. This paragraph expires July 1, 2004. 4 Section 15. Subsection (3) and paragraph (b) of 5 subsection (5) of section 624.91, Florida Statutes, as amended 6 by CS for SB 2000, 1st Engrossed, are amended to read: 7 624.91 The Florida Healthy Kids Corporation Act.-- 8 (3) ELIGIBILITY FOR STATE-FUNDED ASSISTANCE.--Only the 9 following individuals are eligible for state-funded assistance 10 in paying Florida Healthy Kids premiums: 11 (a) Residents of this state who are eligible for the 12 Florida KidCare program pursuant to s. 409.814. 13 (b) Notwithstanding s. 409.814, legal aliens who are 14 enrolled in the Florida Healthy Kids program as of January 31, 15 2004, who do not qualify for Title XXI federal funds because 16 they are not qualified aliens as defined in s. 409.811. 17 (c) Notwithstanding s. 409.814, individuals who have 18 attained the age of 19 as of March 31, 2004, who were 19 receiving Florida Healthy Kids benefits prior to the enactment 20 of the Florida KidCare program. This paragraph shall be 21 repealed March 31, 2005. 22 (d) Notwithstanding s. 409.814, state employee 23 dependents who were enrolled in the Florida Healthy Kids 24 program as of January 31, 2004. Such individuals shall remain 25 eligible until January 1, 2005. 26 (4)(5) CORPORATION AUTHORIZATION, DUTIES, POWERS.-- 27 (b) The Florida Healthy Kids Corporation shall: 28 1. Arrange for the collection of any family, local 29 contributions, or employer payment or premium, in an amount to 30 be determined by the board of directors, to provide for 31 payment of premiums for comprehensive insurance coverage and 44 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 for the actual or estimated administrative expenses. 2 2. Arrange for the collection of any voluntary 3 contributions to provide for payment of premiums for children 4 who are not eligible for medical assistance under Title XXI of 5 the Social Security Act. Each fiscal year, the corporation 6 shall establish a local match policy for the enrollment of 7 non-Title-XXI-eligible children in the Healthy Kids program. 8 By May 1 of each year, the corporation shall provide written 9 notification of the amount to be remitted to the corporation 10 for the following fiscal year under that policy. Local match 11 sources may include, but are not limited to, funds provided by 12 municipalities, counties, school boards, hospitals, health 13 care providers, charitable organizations, special taxing 14 districts, and private organizations. The minimum local match 15 cash contributions required each fiscal year and local match 16 credits shall be determined by the General Appropriations Act. 17 The corporation shall calculate a county's local match rate 18 based upon that county's percentage of the state's total 19 non-Title-XXI expenditures as reported in the corporation's 20 most recently audited financial statement. In awarding the 21 local match credits, the corporation may consider factors 22 including, but not limited to, population density, per capita 23 income, and existing child-health-related expenditures and 24 services. 25 3. Subject to the provisions of s. 409.8134, accept 26 voluntary supplemental local match contributions that comply 27 with the requirements of Title XXI of the Social Security Act 28 for the purpose of providing additional coverage in 29 contributing counties under Title XXI. 30 4. Establish the administrative and accounting 31 procedures for the operation of the corporation. 45 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 5. Establish, with consultation from appropriate 2 professional organizations, standards for preventive health 3 services and providers and comprehensive insurance benefits 4 appropriate to children, provided that such standards for 5 rural areas shall not limit primary care providers to 6 board-certified pediatricians. 7 6. Determine eligibility for children seeking to 8 participate in the Title XXI-funded components of the Florida 9 KidCare program consistent with the requirements specified in 10 s. 409.814, as well as the non-Title-XXI-eligible children as 11 provided in subsection (3). 12 7. Establish procedures under which providers of local 13 match to, applicants to and participants in the program may 14 have grievances reviewed by an impartial body and reported to 15 the board of directors of the corporation. 16 8. Establish participation criteria and, if 17 appropriate, contract with an authorized insurer, health 18 maintenance organization, or third-party administrator to 19 provide administrative services to the corporation. 20 9. Establish enrollment criteria which shall include 21 penalties or waiting periods of not fewer than 60 days for 22 reinstatement of coverage upon voluntary cancellation for 23 nonpayment of family premiums. 24 10. Contract with authorized insurers or any provider 25 of health care services, meeting standards established by the 26 corporation, for the provision of comprehensive insurance 27 coverage to participants. Such standards shall include 28 criteria under which the corporation may contract with more 29 than one provider of health care services in program sites. 30 Health plans shall be selected through a competitive bid 31 process. The Florida Healthy Kids Corporation shall purchase 46 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 goods and services in the most cost-effective manner 2 consistent with the delivery of quality and accessible medical 3 care. The maximum administrative cost for a Florida Healthy 4 Kids Corporation contract shall be 15 percent. The minimum 5 medical loss ratio for a Florida Healthy Kids Corporation 6 contract shall be 85 percent. The health plan selection 7 criteria and scoring system, and the scoring results, shall be 8 available upon request for inspection after the bids have been 9 awarded. 10 11. Establish disenrollment criteria in the event 11 local matching funds are insufficient to cover enrollments. 12 12. Develop and implement a plan to publicize the 13 Florida Healthy Kids Corporation, the eligibility requirements 14 of the program, and the procedures for enrollment in the 15 program and to maintain public awareness of the corporation 16 and the program. 17 13. Secure staff necessary to properly administer the 18 corporation. Staff costs shall be funded from state and local 19 matching funds and such other private or public funds as 20 become available. The board of directors shall determine the 21 number of staff members necessary to administer the 22 corporation. 23 14. Provide a report annually to the Governor, Chief 24 Financial Officer, Commissioner of Education, Senate 25 President, Speaker of the House of Representatives, and 26 Minority Leaders of the Senate and the House of 27 Representatives. 28 15. Establish benefit packages that which conform to 29 the provisions of the Florida KidCare program, as created in 30 ss. 409.810-409.820. 31 Section 16. This act shall take effect July 1, 2004, 47 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 except that this section and section 2 of this act shall take 2 effect May 1, 2004, or upon becoming a law, whichever occurs 3 later, in which case section 2 of this act shall operate 4 retroactive to May 1, 2004. 5 6 7 ================ T I T L E A M E N D M E N T =============== 8 And the title is amended as follows: 9 Delete everything before the enacting clause 10 11 and insert: 12 A bill to be entitled 13 An act relating to health care; amending s. 14 216.341, F.S.; clarifying that certain 15 provisions relate to the disbursement of trust 16 funds of the Department of Health, not county 17 health department trust funds; providing that 18 certain limitations on the number of authorized 19 positions do not apply to positions in the 20 Department of Health funded by specified 21 sources; amending s. 400.23, F.S.; reducing the 22 nursing home staffing requirement for certified 23 nursing assistants; amending s. 409.814, F.S., 24 as amended, relating to eligibility for the 25 Florida KidCare program; providing that a child 26 who is otherwise disqualified based on a 27 preexisting medical condition shall be eligible 28 when enrollment is possible; amending s. 29 409.903, F.S.; amending income levels that 30 determine the eligibility of pregnant women and 31 children under 1 year of age for mandatory 48 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 medical assistance; amending s. 409.904, F.S.; 2 clarifying Medicaid recipients' responsibility 3 for the cost of nursing home care; providing 4 limitations on the care available to certain 5 persons under "medically needy" coverage; 6 amending income levels that determine the 7 eligibility of children under 1 year of age for 8 optional medical assistance; amending s. 9 409.905, F.S.; deleting an obsolete reference; 10 establishing a utilization-management program 11 for private duty nursing for children and 12 hospital neonatal intensive-care stays; 13 establishing a hospitalist program; eliminating 14 transportation services for nondisabled 15 beneficiaries; authorizing the Agency for 16 Health Care Administration to contract for 17 transportation services; amending s. 409.906, 18 F.S.; allowing the consolidation of certain 19 services; authorizing the implementation of a 20 home-based and community-based services 21 utilization-management program; specifying the 22 income standard for hospice care; amending s. 23 409.9065, F.S.; allowing the Agency for Health 24 Care Administration to operate a limited 25 pharmaceutical expense assistance program under 26 specified conditions; providing limitations on 27 benefits under the program; providing for 28 copayments; amending s. 409.907, F.S.; 29 clarifying that Medicaid provider network 30 status is not an entitlement; amending s. 31 409.911, F.S.; establishing the Medicaid 49 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 Disproportionate Share Council; amending s. 2 409.912, F.S.; reducing payment for 3 pharmaceutical ingredient prices; expanding the 4 existing pharmaceutical supplemental rebate 5 threshold to a minimum of 27 percent; 6 authorizing a return and reuse prescription 7 drug program; allowing for utilization 8 management and prior authorization for certain 9 categories of drugs; limiting allowable monthly 10 dosing of drugs that enhance or enable sexual 11 performance; modifying Medicaid prescribed drug 12 coverage to allow for preferred daily dosages 13 of certain select pharmaceuticals; authorizing 14 a prior-authorization program for the off-label 15 use of Medicaid prescribed pharmaceuticals; 16 adopting an algorithm-based treatment protocol 17 for select mental health disorders; requiring 18 the agency to implement a behavioral health 19 drug management program financed through an 20 agreement with pharmaceutical manufacturers; 21 providing contract requirements and program 22 requirements; providing for application of 23 certain drug limits and prior-authorization 24 requirements if the agency is unable to 25 negotiate a contract; allowing for limitation 26 of the Medicaid provider networks; amending s. 27 409.9122, F.S.; revising prerequisites to 28 mandatory assignment; specifying managed care 29 enrollment in certain areas of the state; 30 requiring certain Medicaid applicants to select 31 a managed care plan at the time of application; 50 8:52 AM 04/02/04 h1843c-02j01
SENATE AMENDMENT Bill No. HB 1843, 1st Eng. Amendment No. ___ Barcode 822742 1 eliminating the exclusion of special hospital 2 payments from rates for health maintenance 3 organizations; providing technical updates; 4 amending ss. 430.204 and 430.205, F.S.; 5 rescinding the expiration of certain funding 6 provisions relating to 7 community-care-for-the-elderly core services 8 and to the community care service system; 9 amending s. 624.91, F.S., the Florida Healthy 10 Kids Corporation Act; deleting certain 11 eligibility requirements for state-funded 12 assistance in paying premiums for the Florida 13 Healthy Kids program; requiring purchases to be 14 made in a manner consistent with delivering 15 accessible medical care; providing an effective 16 date. 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 51 8:52 AM 04/02/04 h1843c-02j01